Table 1 Implementation of the MoU in Portugal 2011–2014

Review and increase patient fees

Reduction of exemption categories

Increase inflation-indexed fees

Cut tax allowances for healthcare, including private insurance

Reduce the cost of health benefits schemes for public servants

Reduce costs for patient transportation

Control retail price

Move the responsibility of pricing to the Ministry of Health

Revise the international reference-pricing system

Monitor expenditure monthly and limit public spending

Remove barriers to generic medicines

Change the calculation of pharmacies’ profit margin

Gradually increase the share of generic medicines

Implement existing legislation on the regulation of pharmacies

Speed up the reimbursement of generics

Introduce a contribution paid by pharmacies

Make electronic prescription of medicines and diagnostic tests covered by public reimbursement fully compulsory for physicians (public and private sectors)

Encourage physicians to prescribe generic medicines and less costly branded products (public and private sectors)

Introduce international prescription guidelines for drugs, exams and treatment

Improve monitoring of prescription of medicines and diagnostic services and impose systematic assessments by each doctor of quantity and cost. Introduce sanctions and penalties

Legislative and administrative framework for a centralized procurement system for the purchase of medical goods

Change in the existing accounting framework in hospitals SOEs to that of private companies and other SOEs

Concentration and rationalization of non-hospital care provision

Concentration and rationalization of the hospital network

Continued publication of clinical guidelines and introduction of an auditing system

Benchmarking of hospital performance

Interoperability of IT systems in hospitals

Finalization and regular updates of uniform coding system for medical supplies

Implement the centralized purchasing of medical goods using the uniform coding system

Clearing of existing arrears in the hospital sector and prevention of accumulation of new arrears

Completion of patient electronic medical records

Increase in competition between private providers and reduction in NHS payment of exams and treatments

Centralized monitoring of public-private partnership contracts

Regular revision of fees paid by the NHS for exams and treatment by private providers

Assessment of compliance with European competition rules for the provision of services in the private healthcare sector

Move hospital outpatient services to primary care units

Update working time, increase mobility, adopt flexible time arrangements and review payment mechanisms

Conduct an annual inventory of doctors

Make human resource allocation plans

Increase mobility of healthcare staff within and between regions

Ensure transparent selection of the chairs and members of hospital boards